Governor Charlie Baker on Wednesday signed into law a bill that creates a licensing board to regulate naturopaths, alternative medicine practitioners who have fought for two decades for the right to be licensed in the same way as medical professionals.

The bill, pushed through on the Legislature’s final day, stirred controversy as opponents — primarily the Massachusetts Medical Society — said licensure would grant legitimacy to practices that are merely “a combination of nutritional advice, home remedies, and discredited treatments.”

But naturopaths and their supporters said the legislation will ensure that only qualified people call themselves naturopaths. The governor agreed. “This legislation,” said Baker spokesman Billy Pitman, “ensures an independent professional licensing board is able to implement minimum standards, education, and quality of care in a growing, yet unregulated field.”

As I said when I first noticed how this bill passed the Massachusetts legislature last week through some rather shady means, naturopaths are like The Terminator, as described in the movie of the same name. In their search for legitimacy and licensure, naturopaths “can’t be bargained with. [They] can’t be reasoned with. [They don’t] feel pity, or remorse, or fear. And [they] absolutely will not stop… ever, until they are licensed in all 50 states!” Well, they just notched up state #19.

Not surprisingly, naturopaths are overjoyed:

Amy Rothenberg, president of the Massachusetts Society of Naturopathic Doctors, said in a statement that naturopaths “are thrilled to join the ranks of providers in the state.”

“We applaud Charlie Baker and the legislative process that studied and vetted this profession for over 20 years and came to understand the unique role that naturopathic doctors can play in the state,” she said, adding that naturopaths bring “expertise in both preventive medicine and natural integrative care.”

This is standard-issue naturopath propaganda, and I’ve discussed Amy Rothenberg before. Basically, she is someone who accepted conventional oncologic treatment for her cancer but supplemented it with naturopathic quackery. Now, she mostly attributes how well she is doing to the naturopathic quackery and is an evangelist to bring that quackery to everyone. Same as it ever was.

As is so often the case, organizations of conventional, science-based physicians, were ineffective in stopping the naturopathic juggernaut and are left only to complain:

Dr. James S. Gessner, president of the Massachusetts Medical Society, said in a statement Wednesday that “licensing is likely to be perceived by the public as an endorsement of an area of care that lacks rigorous medical training and standards of care, and offers few if any treatments based on clinical and scientific evidence.”

But he said he was gratified the law prohibits naturopaths from prescribing and ordering medications, using the term “physician,” and portraying themselves as primary care providers.

The law also requires naturopaths to refer unimmunized children to physicians.

Dr. Gessner is deluding himself if he things that these sops to real physicians will stand for long. I predict that it won’t be long before Massachusetts naturopaths start lobbying to remove the prohibition against calling themselves “physicians,” portraying themselves as primary care providers, and prescribing drugs that aren’t controlled substances. It will happen, and soon, because this is the naturopath playbook. They get what they can, and then they go back for more, until they win the right to practice their quackery to the fullest extent of their quackiness. There’s no reason to expect that the situation will be any different in Massachusetts.

If there’s one thing that’s irritated the crap out of me over the last three years or so in my state, it’s how the Michigan State Medical Society threw everything it had to stop bills that would expand the scope of practice of advanced practice nurses to allow them to practice independently to the level of their training, but when it came to bills trying to permit naturopathic licensure they did very little. Fortunately, thus far, such bills haven’t had a lot of support in Michigan, but then the naturopaths haven’t target Michigan yet they way they targeted Massachusetts.

A man who went to jail after using natural remedies to treat his son’s meningitis is going to Prince George, B.C., to promote nutritional supplements sold by his family’s business — a move that is sparking controversy online.

David Stephan and his wife were charged with “failing to provide the necessaries of life” after their nearly 19-month-old son Ezekiel died of bacterial meningitis.

Alberta parents convicted in toddler’s meningitis death
The couple testified they believed Ezekiel had croup or flu and treated him with remedies including hot peppers, garlic onions and horseradish.

Court heard a recording of the couple explaining to police they prefer naturopathic remedies because of their family’s negative experiences with the medical system.

As you might recall, David Stephan works in his family’s supplement business for a company called Truehope. Clearly, and unsurprisingly,he’s learned nothing:

On Jan. 10, Stephan was scheduled to speak about “how his family members suffered from mental illness and were made well,” according to a display at Ave Maria Specialities, an “alternative and holistic health service” store in Prince George.

Stephan works for Truehope Nutritional Support, co-founded by his father.

Truehope produces EMPowerplus, billed on the company’s website as “natural alternative to pharmaceutical medications” aimed at treating mental disorders such as bipolar disorder, ADD/ADHD and stress.

One notes that the sentences Stephan and his wife received were a slap on the wrist.

One can argue (and we have argued) how much of a role the naturopath in this case,Tracy Tannis of the Lethbridge Naturopathic Medical Clinic, had in the death of Ezekiel, given the specific facts of the case and the limited contact she had with Ezekiel and his mother. What can’t be argued is that naturopathy is quackery very much like what killed Ezekiel and that naturopathy and supplement businesses like Truehope selling supplements using pseudoscientific and unsupported claims go hand in hand. Indeed, it’s supplement companies that are funding efforts to pass naturopathic licensing bills in Michigan and several other states. Basically, what Massachusetts just did is to make it easier for naturopaths to kill patients through negligence by providing naturopathic quackery with the imprimatur of the state.

38 Comments

All this on top of Trump is just too much. Massachusetts with all its higher learning resources should know better. Very sad. I have to accept, at this point, that I simply am not going to outlive this New Dark Age we have fallen into.

@darwinslapdog: Massachusetts may have a large number of universities, many of them prestigious, but it also has its share of lunatics. Exhibit A: Jill Stein, MD, of Lexington. Per Wikipedia, she has run for US President twice (2012 and 2016), Governor twice (2002 and 2010), state representative (2004), Secretary of the Commonwealth (2006), and Town Meeting Representative twice (2005 and 2008). Only the last two campaigns were successful. But thousands of voters throughout the Commonwealth have voted for her over the years.

Notorious climate pseudoskeptic Richard Lindzen has an affiliation with MIT, though that’s getting a bit off topic.

There is a woo-infested spa out in Lenox (out in the Berkshires) which has been mentioned once or twice on this blog. They call themselves a ranch, which would be a rather generous description of the grounds. Dr. Mark Hyman, who has been on the receiving end of Orac’s Respectful Influence a few times, is affiliated with this organization.

There are other lunatics in Massachusetts as well. They tend to be of the radical leftist persuasion rather than the hypocritical evangelical persuasion, but they are certainly out there.

One of the favorite strategies of naturopaths and other quacks to try to legitimize their nonsense is to add their treatments to legitimate science-based medicine, watch patients improve, then claim the results were in some part due to the magic. Even at a basic level, acupuncture, homeopathic medicine, reiki etc often is attempted to be justified in…sure let’s call them studies, where it is admitted that those undergoing the alternative treatment are also placed on healthy diets (based on science), scheduled for regular exercise beyond their normal levels pre-illness or injury (again, with scientific backing), or even treated with pharmaceuticals. Then the alternative treatment group is claimed to improve not on the science, but subjective scales of how they feel.

It’s bs, it is easily noticed, but to the random person watching a story on the local news about the power of some random natural oil to treat alzheimer’s? Yeah…not good.

[email protected]: That would be true in the US, but not in Canada, where Mr. Stephan lives. The most US authorities could do is prohibit importation. However, there may be an equivalent Canadian agency which may or may not have similar powers.

Truehope produces EMPowerplus, billed on the company’s website as “natural alternative to pharmaceutical medications” aimed at treating mental disorders such as bipolar disorder, ADD/ADHD and stress.

The CBC seems to have dropped the ball with the quotation marks here: that phrase only occurs in their story. The closest thing at truehope.com that I’m seeing is “natural alternative to psychiatric medications,” from a five-year-old newsletter.

I’m glad Orac called out Big Supplement. As I wrote recently, quackery doesn’t expand on some viral property of it’s (wacky) ideas alone, it’s needs a push from money and power, and supplement profiteers are suspect number one. It’s not just ‘naturopaths’ of course, as the Weil/Hyman/Neides version of ‘Integrated Medicine’ is basically just naturopathy with an ‘MD’ tacked onto the shingle. Supplements! Detox! Help!

That said, there’s an important distinction between naturopathy/supplemental-IM on one hand, and Truehope/Ezekiel’s death on the other. We can consider them both prongs of a larger supplement-quackery assault, but they’re aimed in different directions and work differently.

As the Stephan case unfolded, it became clearer and clearer that the fundamental problem with pointing blame at Tracey Tannis was that David Stephan would never have cottoned taking his child to any ‘professional’ practitioner outside his own family for any sort of care – not just real doctors, anybody. doug and I followed the recent child-death-from-medical-neglect trial of Tamara Lovett, and it was the same deal: total do-it-yourself care, total disregard for any professional provider. Then, two more child death cases since, another in Canada, one in Minnesota. Same thing again, just the parents relying entirely on their own judgements, no practitioners of any kind ever saw the kids.

Then there’s Truehope, whose business model is getting mental health patients to abandon their meds and their psydocs and rely instead on the prescriptions of the Truehope ‘customer service’ hard-sell staff for more and more Pig Pills… With a predictable trail of ruined lives and a few dead bodies as a result.

These are the extreme cases, but I suspect they’re the tip of a very large iceberg of DIY ‘healthcare’ promoted and serviced by profiteers in all sorts of online/mail-order ‘natural remedies’ – be it vitamin supplements, herbals, ‘non-prescription’ homeopathics, ‘detox kits’, and no doubt some new scam forms yet to come. If we consider the target market for this stuff as folks prone to take pseudo-science as equivalent to real science, it would follows that a lot of them don’t trust naturopath fake-doctors any more than they trust MD real doctors. They know what’s best for them. They have ‘done their research’ on Google, and found the Truth. Those people in lab coats have agendas, you know, all of them…

On the other hand, consider how office-visit quacks stay in business. Like any provider of professional services, they have to build a customer base that trusts them and finds some utility in what they provide. They have to appear to deliver things that ‘work’ on a regular basis. This gives them a powerful economic incentive to avoid treating serious illnesses that could expose their incompetence by turning out with negative consequences for their patients. The ‘if you didn’t get better, it’s because you didn’t believe’ excuses only go so far, and don’t exactly fit the natural cures ideology, which isn’t that easy to tie to ‘spirituality’. The promise of supplements and homeopathics is still, ‘if you take this, you will get better’.

Which is why we mainly see office-visit quacks treating fake-diseases, minor health annoyances, self-limiting conditions, chronic conditions for which there are no effective sbm cures, etc. etc. To echo a point Dr. Peter Moran noted at SBM recently, There are an awful lot of office-visit quacks out there. For example, according to the Chiro Association, there are 77,000 licensed DCs in the US, treating “over 27 million Americans annually.” If any significant percentage of these were routinely performing risky spinal manipulations on patients with serious biological illnesses – rather than just boinking common back pains – the trail of tragic outcomes would be too wide and long to hide. Similarly, any naturopath clueless enough to examine a kid presenting with meningitis symptoms, and sending him home with nothing but an OTC echinacea ‘immune booster’ isn’t going to stay in business very long. These providers live in real-life communities, not on the Internet. People talk to their friends in neighbors. Word gets around….

I’m not saying office-visit quacks are OK, or not harmful, or that it’s OK for naturopaths to be allowed to practice at all, much less licensed under the sham of self-regulation. I’m saying there’s no evidence that naturopathic licensing in Massacussets will result in any dramatic increase in wrongful deaths, or any epidemic of lesser dramatic medical harms. It’s still a very, very bad thing, and indeed likely to have bad consequences that are completely unjustifiable. Just not that bad. And the reason I’m saying that is that there’s other phenomena out there that are significantly more troubling, with a stronger evidence base warranting high concern. And I think we need to distinguish between these phenomena, and focus more attention on the ones that present the greater dangers.

I submit, for discussion, the thesis that we can draw distinctions between four categories of CAM use:
1. Total DIY: patient-knows-best; paranoid distrust of all authority; ‘do your own research’; online/mail-order ‘natural cures’. never visit any kind of ‘doctor’ real or fake;
2. Media guided DIY: these users place trust in some ‘celebrity’ expert or pseudo-expert; Dr. Oz, Mark Hyman et all. They buy the diet-cure books, do the online programs, order their supplements from the recommend lists – associated with their guru of choice. They may shift from one guru to another, but they have to have their woo endorsed by some external authority figure to feel OK about it. They avoid the more plebeian local woo practitioners, but probably visit real doctors when they have obviously serious medical problems.
3. Routine patients of typical office-visit quacks; for the most part these are ‘the worried well’ getting some sort of psychological gratification from ‘placebo theatrics’ and hand-holding from providers with whom they’ve established a personal relationship of trust. They may trust their quacks with some more obviously serious medical issues, but are still more likely to go to real doctors when they’re really sick.
4. Patients taken in by major-disease quacks: Cancer quacks, most notably, but also other horror stories like parents taking ASD kids for chelation, and… well, I don’t want to think about it any more, so you can fill in the blanks.

Of course, those are sort of ideal types, and there’s probably some degree of mix and match, but my hypothesis is that if we could chart CAM use by provider involvement and relationship, we’d see four modal peaks corrresponding to these categories. Further, my hypothesis is that these categories represent distinctly different personality types or ideologies or habits of mind, as well as different categories of health concerns, which account for the relative concentrations and relative gaps between them.

I mentioned chiropractic earlier, and In think it’s fairly obvious that different forms of CAM would have different distribution across this provider involvement and relationship scale. I don’t think you can crack your own subluxations, or reach all your acupoints to stick your own needles into them. Naturopathy differs, and I think more problematic in that the base notion of ‘natural cures’ is spread across the whole spectrum. While the natural cures ideologies have distinct and important differences from one type of customer/provider relationship to the next, they are all likely mutually reinforcing and legitimating to some extent.

Thus, while naturopathic licensing probably won’t lead to a trail of broken or dead bodies emerging from naturopathy clinics, to the extent its perceived as legitimating natural cures, supplements, and detox in general will likely lead to more DIY natural cures tragedies. It’s hard to say big the growth may be, but even not-a-whole-lot is too much.

In the end,if this seems like a fairly small departure from Orac’s critique, i do ask you to consider that it’s an important one. ‘Real medicine’ advocates only have so much energy, so much political capital, so much ability to get public attention. Opposing the spread of naturopathy is one of more pressing issues, to be sure. However, it does little to address the spread of DIY alt-med, or the highly profitable industry supplying the books, web courses, TV shows, OTC homeopathics, and supplements, supplements, supplements, supplements, supplements feeding at that trough. So, I’m suggesting sbm advocates ought to devote more attention and effort and resources to that end that they have been up to this point.

@ NJK
in addition to what Zach said, yes they’re not admitting that their ‘natural solutions’ aren’t sufficient for everything and anything. That’s the ‘genius’ in the strategy. That still lets them get away with a bunch of useless or dangerous ‘natural solutions’, for a whole bunch of things. NDs no doubt fall at different points on scales of competence, conscientiousness, woo besotment, and favorite woos. Thus, in addition to the quackery common across naturopathic practice, there are no standards to keep any individual naturopath from presenting quackery as sufficient for something other NDs wouldn’t touch at all, or would use ebm to treat. So we could think of the whole field as something like the difference between Skinnerian conditioning and Pavlovian conditioning. Give ’em three good treatments and they come back for two bad ones, over and over and over.

The Candian authorites have been battling Truehope for years, without success. Tony Stephan apparently has friends in high places, and the $$ to afford legal defenses that overwhelm the Crown’s resources. You can find the history of Truehope at pigpills.com and by Googling ‘Terry Polevoy’ ‘Marvin Ross’, and ‘Ron Reinhold’ – the Truehope scam experts, and authors of the Pig Pills book, much of which is presented, albeit haphazzardly, at the pigpills.com site.

@ Narad
Good call on the muffed quote. Journalists absolutely need to get their attributions right, though failure in that is near epidemic these days.

Of course, Truehope does indeed present products other than EMPowerPlus as “natural alternatives” to pharmaceutical medications other than psych meds. Most notably for RI topics, the base product the Stephans were counting on to cure Ezekiel was Truehope OLE, advertised on the website as an alternative to antibiotics. (Yes, they are that awful… well, actually a lot worse even than that). But you can’t get the real story on what Truehope promises from the website. You have to check the reports of customer calls to/from Truehope. There are sample recording of these linked on the pigpills.com site.

Like Orac I’m sometimes mystified and certainly frustrated by the hostility of many physicians to nurse practitioners.

I know some of them see NPs as “competition.” What I have to think is they view NPs as more dangerous than quacks because most people are rational, and will seek out real health care as opposed to quackery. It takes a lot of volume to keep a practice going in a FFS system,and I know from doctors I’ve talked to that they face real challenges when it comes to staying in business. Not everyone wants to be a cog in a big corporate hospital system wheel, and in some parts of the country that model may not work well due to the costs of supporting the system.

The only other thing I can think of is, some physicians view NPs as more of a threat because we use real science and real medicine in our limited expanded scope of nursing practice, that we’re getting “uppity” and not staying in our place by wanting to have our own independent practices. I see that from physicians who resist calling NPs who hold the DNP “Doctor.” Yet these same physicians have no problem calling a chiropractor “Doctor,” or a psychologist “Doctor.”

I’m sure there are other reasons. And it really bothers me because NPs do a great job within their scope while quacks are allowed to proliferate unchallenged, while doing a great deal of harm.

Panacea, I will be grateful to a NP for the rest of my life and for my life. Aug 10th, I had a heart attack that Liz recognized (totally blocked LAD) and got me to from our health center to one of best cardiologist in our area (over 100 miles away).

Rich, thanks for the kind words. I’m delighted to hear you got such great care. Sounds like you have a GREAT NP.

I’ve had a couple of great NPs; they inspired me to go to NP school myself.

It’s the quacks I just can’t wrap my head around. I think sadmar’s analysis (if exceedingly wordy) did hit on a gem; the variety of motives for people to prefer quacks to real health care provides of any stripe.

It mystifies me why real health care providers don’t organize to stamp out quackery. And I’m not just talking about physicians who buy into the whole CAM thing (and sometimes I have to wonder at their motives for doing so). There are nurses who do it, too.

prn: Penecillins have been considered to be more broadly effective by the high dose vitamin C pioneers when used with IV vitamin C or bowel tolerance oral vitamin C.

PGPOh, great, not only are naturopaths duping patients, but they’re actually contributing to the creation of more penicillin resistant bacteria.

You n=0 “experts” don’t get it. Not NDs,highly experienced MDs saying that they were able to consistently resolve bacterial diseases. Bacterial diseases that otherwise required more specialized or higher powered antibiotics that typically carry more side effects. And higher price tags.

Point blank, I’ve seen chronic conditions that are not cureable where the typical antibiotic creep step-by-step to more nasty stuff never occurred. Hospital tests that showed penecillin resistance due to bioflm were easy to reverse with an IV vitamin C series.

Is this site related to the Genetic Literacy Project? Because you all talk the same sort of angry pious bullshit. That is not how science is supposed to work, unless it is funded by vested interests. So really, it’s pretty obvious why this site was created: to denigrate any alternatives to industrialised medicine and technology. Sad, pathetic, and really nasty.

Well, of course there are weirdos everywhere, I certainly didn’t mean to imply that Mass is not “diversified”. What I meant was that it should be able to muster enough expert opinion to prevent things like this from getting passed into law.

I’d be willing to bet that Big Supplement funds the effort to licence Naturopaths. That would be deeply ironic considering how much squealing we hear from their camp regarding the evil symbiosis between MDs and big pharma.

[email protected]
“Hospital tests that showed penecillin resistance due to bioflm were easy to reverse with an IV vitamin C series.”

That would be very big news. Could you link to a peer reviewed publication? If not, please get busy writing up some grant requests. Hospitals and organized medicine are very interested in approaches to reduce use of antibiotics and reduce the spread/generation of antibiotic resistance.

Hell yeah, Big Supplement funds the effort to licence Naturopaths. Any squealing from the supplement makers is just Turdblossom politics SOP: accuse your opponents of whatever skullduggery you’re up to. The truth is ironic to ‘both sides’, in Congress the ‘supplement shills’ and the ‘pharma shills’ are the same politicos (e..g. Jason Chaffetz). In economic terms (check the shelves at Walgreens) ‘pharma’ and ‘supplements’ are indistinguishable. The manufacturers all support de-regulation, ‘health freedom’ etc., so wind up bankrolling the same pols, who have no great difficulty serving the interests of both. ‘Sad.”

I mean, do you think naturopathic licensing would be gaining ground so much if the pharmas were putting any serious effort into opposing it?

How can you trust the judgement of someone who believes in homeopathy?

Obviously, unless patients dis-believe in homeopathy, they can trust someone who does. In the case of natuopaths, most patients are probably untroubled by seeing ‘homeopathic remedies’ on the list of offerings because they think ‘homeopathic’ is just a fancy word for any kind of ‘natural’ medicine (as shown by the recent FTC research, btw.)

But I’ll go further to address what I take to be a more interesting question: How can someone skeptical of homeopathy per se trust the judgement of a naturopath?

General answer: They don’t find their NDs commitment level, if any, to practicing homeopathy to be relevant to their health needs.

• Just because NDs have to pass a test on the principles of homeopathy doesn’t mean they believe it.
• ‘Belief in homeopathy’ doesn’t necessarily translate to an ND using it often or at all. One ND might be so gung-ho as to prescribe dilutions for everything. Another may be so luke-warm as to prescribe it very rarely for a very small range of conditions. A third, whatever their belief level in the principles, may never prescribe it at all, due to finding some other treatment ‘better’.
• Unless the ND is gung-ho, the patient may never even hear a mention of homeopathy from the provider.
* Patients may simply bracket and separate the providers ‘beliefs’ and practices. ‘I trust her for this, but not for that.’ As I’ve noted before, this is a pretty common way folks dela with experts of all sorts. In medicine, for example, we tend to trust our PCPs with some issues, where for others we insist on seeing a specialist. I’ve met lots of people who visit chiropractors, virtually all of whom make regular visits to real MDs. In general, we could say they don’t trust their PCP to deal with their back pain effectively, and don’t trust their chiro to do anything else. Most folks treat this stuff as a matter of pragmatic results, and never even give a thought to the underlying principles, much less to whether or not they’re consistent.
• Thus, patients who distinguish between homeopathy and natural remedies in general may not fully understand the scientific implausibility, and have only a limited or bracketed skepticism of what they take homeopathy to be. They might blanche at receiving ‘homeopathy’ for many conditions, but willing to give it a shot for others. In this, they are likely to be influenced by opinions and testimony of people in their personal circles they consider generally to be trustworthy and have good judgment.

The Lenox operation is a branch of the Canyon Ranch mothership in Arizona. Tons of woo, plenty of attractive young men and women to escort the rich oldsters, lots of easy money being made.

Wrt Lenox, I am more concerned that the place has become a hotbed of anti-fluoridation nutbaggery than with rich fools paying handsomely for non-treatment of non-problems.

Carrying forward the discussion of the “smart people/stupid irresponsible quackery” paradox, the town has an outstanding school system that regularly turns out scientists and artists of accomplishment.

How can all of this be true, at one and the same time? That is a mystery.

” ‘Real medicine’ advocates only have so much energy, so much political capital, so much ability to get public attention. Opposing the spread of naturopathy is one of more pressing issues, to be sure. However, it does little to address the spread of DIY alt-med, or the highly profitable industry supplying the books, web courses, TV shows, OTC homeopathics, and supplements, supplements, supplements, supplements, supplements feeding at that trough. So, I’m suggesting sbm advocates ought to devote more attention and effort and resources to that end that they have been up to this point.”

Are you suggesting that we take on one supplement and web site at a time? There are around 45,000 supplements in the U.S. and who knows how many web sites, books, and courses. At sites like Mercola’s, posting comments is futile because he has people who block or erase them, no matter how factual and polite. Like the song says, “Who will stop the rain?”

In France, homeopathy is prescribed by MDs, mainly due to patient demand. Patients believe in homeopathy because guidelines do not change with time, unlike in SBM. Only very few people have the ability to change their own belief and to understand that you have to do so with new information.

Orac:
I posted about the david stephan debacle on another site. I live in vancouver and was horrified to see a full page advertisment in the paper where david Stephan uses his now found notoriety (with a big picture of himself) to hawk his vitamins. It gave a schedule of seminars to be given around the city. I immediately wrote a letter to the editor of the local magazine that run this advertisement and got no response. I took a picture of the full page advertisement if you want it to send it to you.

[…] and as a PR strategy to win legitimacy for their pseudoscientific medicine. It’s had considerable success. Their key argument is that licensure will provide a level of regulation that will maintain a […]

[…] bill passed, they always come back again. Eventually, they usually get what they want. That’s what happened earlier this year in Massachusetts. Meanwhile, supplement companies are supporting the efforts of naturopaths to win over state […]